Table 1 Cardiovascular risk factor and disease definitions

Hypertension (HTN)

Average measurements from study enrollment of SBP > 140 mmHg or DBP > 90 mmHg; or at least 1 enrollment BP measurement of SBP > 160 mmHg or DBP > 100 mmHg; or self-reported antihypertensive treatment. Incident HTN is defined as any subsequent study visit BP measurement of SBP > 140 mmHg or DP > 90 mmHg, or initiation or continuation of antihypertensive medications. Stage I HTN is defined as SBP 140–159 mmHg or DBP 90–99 mmHg; Stage 2 HTN is defined as SBP > 160 mmHg or DBP > 100 mmHg.

Diabetes

Fasting glucose > 126 mg/dL or non-fasting glucose > 200 mg/dL, or taking diabetes medications [68, 69]

Obesity

Body mass index > 30 kg/m²

Dyslipidemia

ACC/AHA guidelines for LDL levels based on risk category [70]

Kidney Disease

Urine albumin to creatinine ratio > 30 mg/g or eGFR < 60 mL/min/1.73 m² as calculated using the CKD-Epi equation [71,72,73,74]

Poor diet

< 1 serving of fruits or vegetables per day, added salt to food, or > 1 fried food per day per the WHO STEPS survey definition [48, 75]

Smoking

Self-reported current tobacco smoking

Physical inactivity

< 150 min of moderate activity, or < 75 min of vigorous activity, or < 600 MET minutes per week [76]

Inflammation

hsCRP > 3 mg/L [77, 78]

 Myocardial Infarction (MI)

Universal Definition of MI [79] and an AHA position statement [80] based on three major domains: clinical signs and symptoms consistent with ischemia, a rising and/or falling pattern of cardiac biomarkers over at least 6 h, and ECG or echocardiographic findings consistent with ischemia based on the Minnesota Criteria [81]

 Heart Failure (HF)

Defined by clinical signs and symptoms based on the Framingham clinical diagnosis of HF [82], and adjudication is based on clinical symptoms, imaging findings, and b-type natriuretic peptide levels [82, 83]. We will classify the type of HF as HF with reduced ejection fraction (EF) or preserved EF based on echocardiographic readings.

 Stroke

Based on consensus guidelines and defined as a clinical syndrome consisting of rapidly developing clinical signs of focal (or global in case of coma) disturbance of cerebral function lasting > 24 h or leading to death with no apparent cause other than a vascular origin; imaging findings consistent with infarction may be used even if symptoms resolve in < 24 h [84].

 Cardiovascular Disease Death

Following recommendations set forth in Luepker, et al., using all available information including an interview with next of kin; CVD death includes death due to MI, HF, or stroke [80].